RECONSTRUCTION OF UPPER LIMB TRAUMA

For many patients, audio-visual appointments have provided a timely and efficient way of seeking advice, assessment and treatment for their hand injuries during the NHS response to COVID-19. This study aimed to explore the experience of hand units across the UK in determining the safe and judicious use of audio-visual outpatient care for the management of acute upper limb trauma. An online cross-sectional survey was sent to the therapy leads of hand units across the UK. Questions focused on the experience of using audio-visual technology in the management of upper limb trauma, and the relevant factors in determining its appropriate use. A deductive mixed methods analysis was used to identify both common themes and capture community experience and characteristics. A total of 51 out of 76 hand therapy units completed the survey; a response rate of 67%. Of these, 82% (42/51) reported using audio-visual technology to manage upper limb trauma during the UK COVID-19 lockdown. When determining patient suitability for audio-visual consultations, 73% (37/51) of respondents reported the use of COVID-19 guidelines, but only 35% (18/51) reported the use of a clinical decision-making tool. In agreement with our experience at Salisbury Hospital Foundation Trust, 92% (47/51) had concerns relating to the use of audio-visual care. The choice of safely managed remote care or in-person consultation has, to date, largely relied on the discretion of the clinician. A carefully designed clinical decision-making tool for the management of upper limb trauma is needed for use both in clinical practice and in future service planning.

PurposeThe lockdown imposed in France to cope with the COronaVIrus Disease 2019 (COVID-19) outbreak has led to major changes in the lifestyle of French citizens. The aim of our study was to study its impact on activity related to emergencies in hand and upper limb trauma in comparison to the same reference period in 2019.Material and methodsAll consecutive patients consulting for upper limb injury requiring urgent care at Georges-Pompidou European Hospital (HEGP), France, during the lockdown period (case group) and the equivalent period in 2019 (control group) were included. In each group, the type of accident, the anatomical location of the injury, and the treatment were reported and compared.ResultsTwo hundred seventy-five patients were included in the case group in comparison to 784 patients in the control group. We observed a two-third decrease in the rate of upper limb emergencies (− 64.9%) in particular a drastic drop in the rate of road, work, and leisure accidents (10.4% vs 14.3%, p = 0.1151; 10.0% vs 22.6%, p < 0.0001; 13.1% vs 30.8%, p < 0.0001, respectively), and a clear increase in domestic accidents (66.5% vs 32.3%, p < 0.0001). The aetiologies were more dominated by lacerations of soft tissues (48.4%, vs 38.3%, p = 0.0034) and infections (8.7% vs 5.1%, p = 0.0299) with an increase in the indications for surgical management (51.2% vs 36.9%, p < 0.0001). Conversely, we observed fewer consultations for joint injuries (20.7% vs 30.7%, p = 0.0015) and fractures (22.2% vs 25.9%, p = 0.2210).ConclusionThe lockdown imposed in France has changes the etiologies and the management of hand and upper limb emergencies.

Introduction: The aim of this study was to evaluate the mechanism and type of upper limb arterial trauma in Iranian population. Methods: Fifty-one patients with upper limb trauma were evaluated over a 4-year period with conventional angiography at the Tabriz Imam Hospital, Iran. Results: Twenty-four patients (19 men, 5 women with a mean age of 27.5 ± 11.8 years) had arterial injuries. Blunt trauma was more frequent than penetrating trauma (87.5%). The most cause of trauma was traffic accidents and the brachial artery was the most frequently affected artery. In 87.5% cases associated bone injuries were observed. Conclusion: Patients with blunt upper limb injuries must be evaluated for vascular integrity timely, especially in traffic accidents because vascular injuries after traffic accidents need to be referred to vascular centers. The results of this article are of potential use and clinical importance because precise diagnosis of vascular insults are essential to restore injured extremities.

Upper extremity trauma and resulting disability is a stressful event and can affect a patient's personality. Several studies have shown that this injury type has serious psychological and/or social consequences. We systematically reviewed the evidence on the consequences of disability after a complex trauma (combination of soft tissue, osseous, vascular, and nerve involvement) of the upper extremity. We tried to find out the potential crucial factors that could determine the final hand function. In addition, we considered the challenges that need to be addressed to eliminate the adverse or negative effects that arise from upper limb trauma. In the literature, there is a growing interest to study changes in patients' quality of life and return to work. Psychological morbidity is an important part of patients' perceived general health. These issues could play an important role in the final functional outcome of the therapy. An early identification and treatment of trauma-related distress in patients may prevent progression of psychological pathology and mitigate negative effects on general health status. It may be important to evaluate the amount of psychological distress when caring for patients with hand injuries.

Introduction Reduced upper extremity function after stroke has previously been reported in 70-80% of patients with stroke in the acute stage and is one of the most common impairments after acute stroke impaired motor function, both in upper and lower extremity, influence the stroke unit care and planning of the rehabilitation, partly due to the economic costs. There is limited information in upper extremity function within the first days after a stroke. Prior studies include either both first and recurrent stroke or only one type of stroke. Objectives To investigate the frequency impaired arm and hand function in an unselected group of patients with first occasion of stroke. Method All patients at a stroke unit at Sahlgrenska University Hospital were assessed during 18 months. From the hospital records, the patients were identified, the patient charts were read and first stroke diagnosis was confirmed (by either imaging or clinical assessment). Impaired upper extremity function was defined in the following manner: assessed with the Modified Motor Assessment Scale (M-MAS UAS -95) by physiotherapist working at the stroke unit within 72 hours after stroke onset or if this was found in the patients chart, other standardized assessments of upper extremity function performed by the physical therapist, the occupational therapist or the physicians on the ward. Results During the study period 984 patients with first ever stroke (438 women 44.5%) were admitted to the stroke unit. A total of 213 patients were not at the stroke unit within 72 hours after onset and therefore excluded; 90 patients had unclear stroke onset time, 49 patients were located at another ward, 36 patients were in the intensive care unit, 25 in other hospitals in Sweden and 12 patients were hospitalized in another country. There were 771 patients over 18 years old at the stroke unit within 72 hours after stroke onset. Of these 56 patients (7.3%), were not living in the catchment area and therefore excluded. Of the 715 patients living in the geographical catchment area, 58, (8.1%) hade other upper extremity injury prior the stroke onset. Of the remaining first ever stroke patients (n=657), 311 patients (47.3%) hade impaired arm and hand function within 72 hours after stroke onset. Conclusion The frequency of impaired upper extremity function in this unselected population of first occasion of stroke is lower than previously reported. The Copenhagen stroke study noted 69 % impaired at admission and 43 % at one week. This indicates that today’s stroke patients present less frequent with impaired motor function in the upper extremity. However, they may have difficulties in functional activities which may influence content of rehabilitation process.

Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke

Basic techniques in microsurgery applications of microsurgery in bone tumour microsurgery for special upper limb problems microsurgery for special orthopaedic problems, P.C. Leung application of microsurgery in upper limb trauma, Y.D. Gu muscle graft, Y. Ikuta nerve plexus injuries, A. Narakas peripheral nerve injury, A. Landi microsurgery in lower limb trauma, M.J. Yaremchuk and A.J. Weiland.

Immediate Tissue Transplantation in Upper Limb Trauma: Spare Parts Reconstruction

Upper limb trauma cases vary from simple to high energy impactful injuries, with different etiologies; situations which frequently require unique, demanding and challenging endeavors in order to obtain the most favorable outcome. Experience, good decision-making and knowledge of functional goals are mandatory in order to elaborate a therapeutic plan and execute it accordingly. Although cases differ in nature and prognosis, respecting a set of therapeutic principles whilst dealing with either simple or complex cases, will enhance patient outcome and give the surgeon the confidence to tackle any kind of upper limb trauma. After clearing out vital threat, the emergency surgery represents the first threshold in achieving and restoring normal function and biomechanics, mostly in young and labor active patients, with the mindset to salvage as much tissue as possible, with a thorough debridement and step-by-step approach to different types of tissues. Secondary surgery and reconstructive surgery can be planned timely, with prior discussion with both the therapist and the patient in order to enhance patient’s upper limb function and aesthetic and ensure social reintegration.

Upper limb injuries are common and account for a significant number of emergency department and primary care consultations. While surgery for these injuries is well-documented, nonoperative treatments, particularly the optimal duration of immobilization, remain understudied. These durations are often based on institutional dogma rather than scientific evidence, which have gone unchallenged for years. However, prolonged immobilization can lead to increased morbidity or even complications for patients. The aim of this systematic literature review is to update the recommendations regarding optimal immobilization durations for the most common shoulder and elbow injuries, in order to provide guidelines for primary care and emergency medicine.

Background:There is literature on epidemiologic trends in acute primary tendon ruptures. However, most of the data used in the literature is centered in Europe or Canada, whereas there has been little analysis of trends in primary tendon ruptures in the United States (US), especially data collected after 2010.Purpose:To report the epidemiology of upper and lower extremity acute primary tendon ruptures presenting to emergency departments (ED) in the US and compare incidence ratios based on race using the National Electronic Injury Surveillance System (NEISS) Database.Study Design:Descriptive epidemiology study.Methods:The NEISS database was queried for acute primary tendon ruptures in the US from 2001 to 2020. National estimates (N) and estimated incidence ratios (IR) reported as per 100,000 person-years at risk (PYR) for acute primary tendon ruptures were calculated using NEISS sample estimates (n) and US Census Bureau population estimates. Temporal trends in annual IRs throughout the study period were assessed with regression analyses.Results:From 2001 to 2020, there were an N of 235,189 (95% CI, 186,833-283,546) ED visits for acute tendon ruptures in the US, which occurred in a population of 6,183,899,410 person-years for an overall IR of 3.80 PYR (95% CI, 3.02-4.59). Acute primary Achilles (38.2%), biceps brachii (16.2%), and patellar tendon (12.7%) ruptures were the most common injuries. Black patients had the highest overall IR, with an N of 38,679 ruptures (95% CI, 21,552-55,807) occurring in this group for an overall IR of 4.78 PYR (95% CI, 2.66-6.89). The IR of lower extremity tendon ruptures was significantly higher in Black patients, but did not differ for upper extremity tendon ruptures. The annual incidence of all tendon ruptures in the US increased significantly from 2001 to 2020, with an average annual percent of 3 (95% CI, 2.3-3.7; P < .0001).Conclusion:Our study demonstrated that the IR of acute primary tendon ruptures presenting to the ED in the US has increased from 2001 to 2020. Black/African-American individuals have an increased IR compared with White populations.

The obliteration of the cyst cavity after evacuation is a controversial procedure in hepatic hydatid disease. There is no ideal surgical technique which can be used in all hydatid cyst cavities. Since 1989 we have been using a new technique, which we call overlapping, in the treatment of suitable cases of hepatic hydatid cyst cavities. The technique depends on the obliteration of the cavity without drainage. After evacuating the hydatid material from the cavity, instillation of the cystic cavity is performed with scolecidal agent (silver nitrate solution, 0.5%). The cavity is opened along its long axis. The pericyst is prepared, and the upper edge is sutured to the bottom of the cavity with absorbable stitch (modified external collapse). Before doing this, if there is no possibility of operative ultrasonography, the cavity is punctured with a fine needle to evaluate any dangerous areas. Then the other edge of the pericyst is laid down beside the collapsed one and sutured to the former with the same technique. The term “overlapping” stems from this second procedure. During the operation, we decide which pericyst will collapse and which one will overlap. Before overlapping, openings between the cavity and biliary tree should be found and if there are any, they should be secured. In cases of large and multiple openings, T-tube choledochostomy is necessary. We applied overlapping to 31 of 43 hepatic hydatid cysts (ranging from 5 to 17 cm in diameter, with a mean of 12 cm) in 19 patients. Twenty-four of 31 cysts had partial pericystectomy before overlapping. Three cystic cavities were connected to the biliary tree. Because of a large connection, T-tube choledochostomy was added in one case. We have not seen any complications, either infection or biliary fistula. The results of the obliteration of cavities were excellent in 15 cysts. There were no residual cavities

Purpose/Hypothesis: Loss of hand function in people with hemiparesis is a major contributor to disability post stroke. To use the hand for functional activities, a person may need adequate control of the more proximal upper extremity segments to appropriately position and orient the hand with respect to the environment, and may need adequate control of the fngers to manipulate objects within the environment. The purpose of this study was to examine how loss of movement control at proximal, middle, and distal segments of the upper extremity related to hand function in people with hemiparesis early after stroke, the time period when most people receive therapy. Number of Subjects: We tested 19 people with acute hemiparesis (21.7 ± 6.5 days) due to stroke with a mean age of 55.7 (± 11.0) years. Materials/Methods: We used 3-D kinematic techniques to study isolated movements at the shoulder, elbow, forearm, wrist and 5 fingers. For each segment, we quantified how far it could move (AROM), how well it could move by itself (individuation), and how well it could stay still when it was not instructed to move (stationarity). Hand function was measured using a battery of 6 clinical tests, and principal components analysis was used to create a single, sensitive hand function score for each subject from the test battery. Results: We found that movement control at all 9 segments was correlated with hand function regardless of how it was quantifed. Generally, AROM was more strongly correlated with hand function than either individuation or stationarity. Movement control at the shoulder had strong relationships with hand function for both AROM and individuation, suggesting the importance of proximal control for functional use of the hand. Regression analysis indicated that a large portion of the variance in hand function could be explained by movement control at the 9 segments. Interestingly, much of the explained variance was shared across segments, and was not contributed uniquely by specific segments. Conclusions: Our results suggest that early after stroke, loss of hand function in people is due to loss of movement control at many segments and not due to loss of distal movement control alone. Interestingly, these findings are similar to data from our study in a population with chronic stroke. Clinical Relevance: Measuring AROM in individuals with acute hemiparesis may be a critical impairment to assess and one that is relatively easy to measure with a goniometer. Furthermore, it may be important to focus intervention strategies not only on the hand, but also on the shoulder and elbow in order to influence hand function.

Background: Stroke contributes to disability and mortality worldwide, with upper limb impairments significantly reducing arm and hand function, leading to profound disability. Traditional rehabilitation often lacks effectiveness in fully restoring upper limb function post-stroke. Powered exoskeletal systems offer adaptive support customized to stroke survivors’ needs. This review explores their development, advancements, and clinical applications, emphasizing their potential to improve motor recovery and independence in stroke survivors. Aim: To review evidence of the Soft Robotics for upper limb function in individuals with stroke. Relevance: This study explores the evidence of Soft Robotics as an intervention in Upper limb rehabilitation in Stroke, providing valuable insights for advancing evidence – based practices in physiotherapy. Methods: Data Identification- Search was done on the Pubmed databases, and search engines google scholar, research gate, Sci-Hub, Directory of Open Access Journals. Study Selection-Articles were identified. 10 studies published between 2018 to 2024 were reviewed. Results: A total of 10 studies of Soft Robotics f as an intervention in Upper limb rehabilitation in Stroke, most studies reflect significant improvement in hand function, more accurate &amp; more portable, reducing cost of rehabilitation, friendly use- user interface thus enhance independence among stroke survivors. Conclusion: Development of Soft Robotics as an intervention in Upper limb rehabilitation in Stroke, shows promising results in field of rehabilitation. Future research should focus on exploring more data, improved customization and clinical trials, affordability, and home-based designs to broaden accessibility&amp; effectiveness in rehabilitation.

A pilonidal sinus (PNS) is a small cyst or abscess that occurs in the cleft at the top of the buttocks. A PNS usually contains hair, dirt, and debris. It can cause severe pain and can often become infected. If it becomes infected, it may ooze pus and blood and have a foul odor. The exact cause of pilonidal sinuses is unclear. It is generally thought they are caused by loose hairs pushing into the skin. They could also be caused by deep layers of skin being stretched and moved, leading to a hair follicle rupturing.